Mojtaba Taghizadeh-Armaki1,2,3, Mohammad T Hedayati2,1, Vahid Moqarabzadeh4, Saham Ansari5, Saeed Mahdavi Omran3, Hossein Zarrinfar6, Sasan Saber7, Paul E Verweij8, David W Denning9, Seyedmojtaba Seyedmousavi1,8,10. 1. Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran. 2. Department of Medical Mycology and Parasitology, School of Medicine, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran. 3. Department of Medical Mycology and Parasitology, School of Medicine, Babol University of Medical Sciences, Babol, Iran. 4. Department of Biostatistics, Faculty of Health, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran. 5. Department of Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 6. Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. 7. School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 8. Department of Medical Microbiology, Radboudumc and Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands. 9. The National Aspergillosis Centre, University Hospital of South Manchester, University of Manchester, Manchester, Academic Health Science Centre, Manchester, UK. 10. Present address: Molecular Microbiology Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Maryland, USA.
Abstract
PURPOSE: The detection of galactomannan (GM) in bronchoalveolar lavage (BAL) fluid is an important surrogate marker for the early diagnosis and therapeutic monitoring of invasive aspergillosis (IA), regardless of the involved species of Aspergillus. Here, we utilized the Platelia Aspergillus GM enzyme immunoassay (Bio-Rad) to evaluate the GM index in BAL fluid samples from patients with proven, probable or putative IA due to Aspergillusflavus versus Aspergillusfumigatus. METHODOLOGY: In a prospective study between 2009 and 2015, 116 BAL samples were collected from suspected IA patients referred to two university hospitals in Tehran, Iran. KEY FINDINGS: According to European Organization for Research and Treatment of Cancer and Mycoses Study Group and Blot criteria, 35 patients were classified as IA patients, of which 33 cases tested positive for GM above 0.5 and, among these patients, 22 had a GM index ≥1. Twenty-eight were culture positive for A. flavus and seven for A. fumigatus. The GM index for A. flavus cases was between 0.5-6.5 and those of A. fumigatus ranged from 1 to 6.5. The sensitivity and specificity of a GM index ≥0.5 in cases with A. flavus were 86 and 88 % and for A. fumigatus patients were 100 and 73 %, respectively. CONCLUSION: Overall, the mean GM index in patients with A. fumigatus (3.1) was significantly higher than those of A. flavus (1.6; P-value=0.031) and the sensitivity of GM lower for A. flavus when compared to A. fumigatus. This finding has implications for diagnosis in hospitals and countries with a high proportion of A. flavus infections.
PURPOSE: The detection of galactomannan (GM) in bronchoalveolar lavage (BAL) fluid is an important surrogate marker for the early diagnosis and therapeutic monitoring of invasive aspergillosis (IA), regardless of the involved species of Aspergillus. Here, we utilized the Platelia AspergillusGM enzyme immunoassay (Bio-Rad) to evaluate the GM index in BAL fluid samples from patients with proven, probable or putative IA due to Aspergillusflavus versus Aspergillusfumigatus. METHODOLOGY: In a prospective study between 2009 and 2015, 116 BAL samples were collected from suspected IApatients referred to two university hospitals in Tehran, Iran. KEY FINDINGS: According to European Organization for Research and Treatment of Cancer and Mycoses Study Group and Blot criteria, 35 patients were classified as IApatients, of which 33 cases tested positive for GM above 0.5 and, among these patients, 22 had a GM index ≥1. Twenty-eight were culture positive for A. flavus and seven for A. fumigatus. The GM index for A. flavus cases was between 0.5-6.5 and those of A. fumigatus ranged from 1 to 6.5. The sensitivity and specificity of a GM index ≥0.5 in cases with A. flavus were 86 and 88 % and for A. fumigatuspatients were 100 and 73 %, respectively. CONCLUSION: Overall, the mean GM index in patients with A. fumigatus (3.1) was significantly higher than those of A. flavus (1.6; P-value=0.031) and the sensitivity of GM lower for A. flavus when compared to A. fumigatus. This finding has implications for diagnosis in hospitals and countries with a high proportion of A. flavus infections.
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